Individual provider Active NPI

Ryan Christopher Vincelli, O.D.

  • Optometrist
  • Worthington, MN
National Provider Identifier
1306952031
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2887 Issued in MN
Practice address
1055 Ryans Rd
Worthington, MN 56187-1721
Phone
(507) 376-9212
Fax
(507) 376-9235
NPI assigned
Aug 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2887 MN Primary

Addresses

Primary practice location

1055 Ryans Rd
Worthington, MN 56187-1721

Mailing address

1055 Ryans Rd
Worthington, MN 56187-1721
Phone (507) 376-9212

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050418000561 MN Practitioner - Optometry 7113965534 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1055 Ryan Rd
Worthington, MN 56187-1721
Phone (507) 376-9212

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2887MNMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vincelli Optometry Inc. Optometrist CurrentSince Apr 4, 2007 Accepting new patients

Locations

1055 Ryans Rd
Worthington, MN 56187
Phone (507) 376-4080

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306952031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 RYANS RD",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871721",
            "telephone_number": "507-376-9212",
            "fax_number": "507-376-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 RYANS RD",
            "city": "WORTHINGTON",
            "state": "MN",
            "postal_code": "561871721",
            "telephone_number": "507-376-9212",
            "fax_number": "507-376-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCELLI",
        "first_name": "RYAN",
        "middle_name": "CHRISTOPHER",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worthington, MN

Sources for this page

Verify at the official NPI Registry.